Telepsychiatry, a subfield of telemedicine, is often look to as a method of providing, mental health care to ruraL, under-served communities. Reservation-based rural American Indian communities are geographically isolated, widely dispersed, and often possess fewer resources than their non-Native neighbors, creating problems in accessing much needed health care. Telepsychiatry holds enormous potential to address the mental health needs of this under-served population. The goal of this research is to develop and apply methods to examine the effectiveness, diffusion, and adoption of telepsychiatry in American Indian communities. This project has the following specific aims: 1) to examine the impact of telepsychiatry on the patient-provider relationship, especially cultural aspects thereof; 2) to assess the clinical as well as more general mental health outcomes of telepsychiatric treatment of American Indian veterans seen for PTSD; 3) to assess the programmatic outcomes of several similar telepsychiatric services, with particular emphasis on feasibility, sustainability and cost outcome analysis; 4) to examine factors influencing the diffusion and adoption of telepsychiatry within and between tribal, state, and federal organizations providing health care to rural American Indian communities. This research will be pursued through a specific telepsychiatry program, composed of 3 rural telepsychiatry clinics that provide ongoing treatment for American Indian Veterans with post-traumatic stress disorder. Data on process and outcomes will be collected from routine clinic data, and self-report surveys measuring changes in symptoms, service utilization, and social functioning of 60 American Indian Veterans undergoing treatment in these clinics. Data on diffusion and adoption will be obtained through semi-structured telephone interviews with respondents from federal, tribal, and state organizations involved in these clinics. By assessing telepsychiatry at these different levels of care - namely, patient/provider, program, and organizational system -- this project will address critical gaps in our understanding of the diffusion of this innovative mental health practice in American Indian communities, as well as cultural issues and outcomes related to telepsychiatric services. The findings will serve as a long overdue guide for developing telepsychiatry programs and policies among American Indians, specifically, and rural populations in general.